POS0720 LOW-DOSE GLUCOCORTICOIDS WITHDRAWN IN SYSTEMIC LUPUS ERYTHEMATOSUS: A DESIRABLE AND ATTAINABLE GOAL
Authors: L. Ji, D. Gao, Y. Hao, Z. Zhang
Journal: Annals of the Rheumatic Diseases (2022)

Background Prolonged use of GC may cause irreversible organ damage, leading to impaired quality of life and even increased mortality. However, many physicians are worried about severe flares after GC withdrawal in daily practice. Objectives To assess the risk of flare in systemic lupus erythematosus (SLE) patients after low dose glucocorticoids (GC) discontinuation and evaluate the risk factors of flare. Methods SLE patients who ever discontinued GC were identified from PKUFHS cohort. The disease flare profile after GC discontinuation were analyzed. Flare rate was analyzed using Kaplan-Meier analysis. COX regression was used to determine the effect of variables on SLE flare. A prognostic nomogram using Cox proportional hazards regression modeling were developed. Results 132 SLE patients were eligible for the final analysis. They were followed up for a median (IQR) period of 21.8 (9.01, 36.7) months. The cumulative probability of flare after GC discontinuation was 8.3 % at 6 months, 16.8% at year 1 and 27.5% at year 2 (Figure 1A). In multivariate COX analysis, hypocomplementemia and serologically active clinically quiescent (SACQ) were independent risk factors of flare [HR 2.53, 95% CI (1.32, 4.88); HR 3.17, 95% CI (1.44, 6.97), respectively]. Age ≥ 40y at GC withdrawal and hydroxychloroquine usage were independent protective factors of flare [HR 0.53, 95% CI (0.29, 0.99); HR 0.32, 95% CI (0.17, 0.62), respectively] (Table 1). The protective effect of hydroxychloroquine was dosage related. From the prospective of different tapering strategies embodied as duration from prednisone 5mg/d to complete discontinuation, slower tapering strategy (12-24 months) significantly reduced the risk of flare compared to faster tapering strategy (&lt; 3 months) [HR 0.30, 95% CI (0.11, 0.82), p=0.019]. The prognostic nomogram including aforementioned factors effectively predicted 1- and 2-year probability of flare-free (Figure 1B). Table 1. Predictors of flare by univariate and multivariate COX analysis. Univariate p Multivariate p Multivariate p Model 1 Model 2 age≥40y at GC withdrawal 0.59 (0.33,1.07) 0.084 0.53 (0.29, 0.99) 0.049 0.63 (0.33, 1.18) 0.147 Age at onset ≥18y 2.03 (0.62, 6.66) 0.244 2.75 (0.77, 9.85) 0.121 2.88 (0.81, 10.2) 0.103 Remission duration≥60 months since the last flare 0.66 (0.35, 1.27) 0.217 0.81 (0.41, 1.57) 0.526 0.73 (0.38, 1.41) 0.346 history of thrombocytopenia 1.73 (0.94, 3.18) 0.077 1.36 (0.70, 2.65) 0.359 1.45 (0.74, 2.83) 0.278 history of lupus nephritis 0.86 (0.47, 1.55) 0.610 / / / / Hypocomplementemia 1.97 (1.06, 3.66) 0.031 2.53 (1.32, 4.88) 0.005 / / anti-dsDNA positive 1.25 (0.70, 2.23) 0.456 / / / / SACQ (both) 2.91 (1.38, 6.15) 0.005 / / 3.17 (1.44, 6.97) 0.004 SACQ (or) 1.29 (0.73, 2.30) 0.380 / / / / Hydroxychloroquine or not 0.29 (0.16, 0.53) &lt;0.001 0.29 (0.15, 0.56) &lt;0.001 0.32 (0.17, 0.62) 0.001 Immunosuppressant or not 0.77 (0.40, 1.48) 0.426 / / / / There was strong collinearity between hypocomplementemia and SACQ, so the two parameters were separated into two models. SACQ (both): anti-dsDNA positive and hypocomplementemia; SACQ (or): anti-dsDNA positive or hypocomplementemia; GC: glucocorticoids. Data were shown as HR (95% CI). Figure 1. Conclusion Low-dose GC is feasibly discontinued with infrequent flare in real-life setting. SACQ and younger age are potential risk factors of SLE flare, while hydroxychloroquine usage and slow GC tapering to withdrawal can reduce relapse. The visualized model we developed may help to predict risk of flare among SLE patients who discontinued GC. Disclosure of Interests None declared